"our study can help inform the decisions that prescribers and patients make"
Antidepressant escitalopram has emerged as one of the most effective for preventing relapse, according to a major analysis involving nearly 10,000 patients.
The study, published in The Lancet Psychiatry, compared more than a dozen commonly prescribed antidepressants to assess how effectively they help people remain free from depression symptoms after recovering.
Researchers found that escitalopram performed best at preventing relapse, with agomelatine and duloxetine ranking next. Fluoxetine, widely known by its brand name Prozac, also performed well but ranked just below these medications.
However, experts have cautioned against interpreting the findings as a reason for everyone with depression to switch medication, stressing that the differences between the drugs were relatively modest and that treatment needs to be tailored to individual patients.
Depression affects around one in six people in the UK and, although many make a good recovery with appropriate treatment and support, symptoms can return.
Doctors generally recommend that patients continue taking antidepressants for at least six months after their depression symptoms have improved before gradually reducing their medication to help prevent a relapse.
The latest analysis examined previous studies involving nearly 10,000 people who had been prescribed different antidepressants for periods of up to a year.
It assessed how well the medications helped patients maintain their recovery, as well as whether they continued taking their treatment.
Compared with fluoxetine, patients taking escitalopram were more likely to experience an improvement in their symptoms and remain well, while also being less likely to stop taking their medication.
Agomelatine, an atypical antidepressant, and duloxetine, a serotonin-noradrenaline reuptake inhibitor (SNRI), also performed well. Other medications, including sertraline, did not demonstrate the same advantages.
One of the researchers, Professor Eric Ruhé from Radboud University in the Netherlands, said:
“Nevertheless, our study can help inform the decisions that prescribers and patients make together: if you start an antidepressant, choose one that not only helps you to get well, but also keeps you well.”
Dr Sameer Jauhar, an expert at Imperial College London, said the research provided useful information but warned “it cannot tell us which antidepressant will work best for an individual patient”.
He added: “I would not interpret these findings as a reason for someone who is responding well to their current antidepressant to change treatment.”
Professor Allan Young from the Royal College of Psychiatrists also stressed that individual circumstances remain important when deciding which antidepressant to prescribe.
“While some medicines appear to have a small advantage over others for longer-term outcomes, the differences are modest and are unlikely to outweigh individual factors such as side effects, previous response and patient preference when deciding on treatment.”
Escitalopram belongs to a group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which are commonly recommended as a first-line treatment for depression.
Other commonly prescribed SSRIs include sertraline and fluoxetine. They work by increasing the availability of serotonin, a chemical messenger in the brain associated with regulating mood.
However, escitalopram is not suitable for everyone and, like other antidepressants, can cause side effects. These include sleep problems, constipation and weight gain, although not everyone taking the medication will experience them.
The NHS says doctors may recommend trying a different type of antidepressant, such as an SNRI, if an SSRI like escitalopram is ineffective or unsuitable.
Older tricyclic antidepressants, including amitriptyline, are now prescribed less frequently.
There are also other treatment options for depression, including talking therapies and mindfulness, with the most appropriate approach depending on a person’s circumstances and needs.
Mental health charity Mind said: “It’s common for people to need to try more than one medication before they find the right treatment that works for them.
“And what works may change over time.”
Researchers have also acknowledged that longer studies are needed to better understand the differences between antidepressants and their effectiveness over time.
